What are the responsibilities and job description for the APPEALS SPECIALIST position at UHS?
Responsibilities
The Pre-Cert/Appeals Specialist is responsible for coordinating and monitoring appropriate utilization and documentation of services within 24 hours of admission for treatment of patients admitted to inpatient treatment and coordinate authorization with third party payors. Pre-Cert/Appeals Specialists also review cases for appropriateness of admission, continued stay, and appeals. They assist in the promotion and maintenance of high-quality patient care through the analysis. Review and evaluation of clinical practices within the Behavioral Health Center. Other duties include documentation of authorizations in Midas and MS4 computer systems, maintaining communication system based on documentation and verbal exchange regarding treatment between third-party payors and concurrent reviewers; and communicating with internal and external entities to facilitate acquisition of resources, assisting appeals for UR, and other duties as needed.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
The Pre-Cert/Appeals Specialist must have a Bachelor’s, Master’s Degree preferred, or RN Licensure from an accredited college or university in Social Work, Mental Health or a related field.
Salary : $0
